Question:
To transect or not to transect, that is the question?

I have been looking into two different surgeons both have good reputations, and great skill at what they do, both work out of EXCELLENT hospitals. Anyway, one surgeon transects and one doesn't. My question is how does transecting effect WLS as opposed to a surgeon that does not transect? The Surgeon whom does not transect does the RNY open, the surgeon that transcets does it LAP. Which do you have and why?    — Marlene N. (posted on May 15, 2002)

May 15, 2002
While I am still pre-op here is what I have learned. Transection can be good in the way that there is absolutely NO CHANCE of a staple line disruption and non-transection has that risk. If that happens you will need a revision. Lap surgery can be alot easier on the patient. It is MUCH less evasive and recovery time can be cut in half or more. I had my gall bladder removed Lap and it was done out-patient then I went shopping for a TV before going home from the hospital. Plus Lap gives you nearly zero chance of getting an incisional hernia. I am definately going Lap and having transection. GoodLuck in your decision!
   — Karen W.

May 15, 2002
I was lucky, my doctor ONLY transects, and ONLY does it open. Given the choice, I'd go for lap AND transected. There's a reason my surgeon ONLY transects...too many people from when he didn't transect had staple line disruptions. So he started transecting. Simple as that! ALSO, insurance companies ONLY PAY for ONE revision...and going from non-transected to transected IS a revision...do it right the first time! Then you don't have to worry about it!
   — Becky H.

May 15, 2002
I have a non-transected open RNY (5 months-70lbs) My doctor does not do Lap or transected pouches. His reasons...small percentage of disruptions occur. Personally Even if he had offered transected at the begining I would not have taken it..purely mental reasons..I had a fear that I would be in that small percentage that do not do well with surgery and need it reversed..If it is transected, it cannot be reversed. If I was offered it now,I still would not, things are going well for me , but I do worry from time to time that I will have a SLD and have problems. As far as open vs Lap...I had my gallbladder removed Lapand the WLS was open...maybe a little more recovery time with open. I may have taken the lap for recover time reasons, but open was nice because if anything looked a little off inside the doctor would have taken a biopsy right then. I do not feel either transected or non transected or open or lap are better than the other..I think after you have all the info you need, you will make a decision that is best for you. Best wishes on your journey!
   — Patricia R.

May 15, 2002
I would definately opt for the transect. I know a lady who just had staple line, and it became disrupted and now has to go back and redo surgery, but doesn't have any insurance because she got divorced and lost her husband's insurance. With just staples, there is always that chance of needing a revision sometime down the road. Your surgeons seem to be opposite of most in that most opens transect the stomach and many laps only staple. I had transect open RNY 10 weeks ago, but lap wasn't really an option for me because I had such a high BMI (63) and most lap surgeons won't do laps on bmi's over 50. My surgeon does say that transect can be reversed, just a really major surgery, but very few ever need it. If I had a surgeon that did Lap transection, I would go with him if you feel confident in him.
   — Dell H.

May 15, 2002
Transection of the stomach is considered to be the "gold standard" of RNY surgery. It virtually eliminates the possibility of staple line disruption and leaks, and it is NOT accurate information that transected RNY surgery cannot be reversed. The ability to reverse or revise this surgery depends on the experience and expertise of the surgeon in the field of bariatric surgery. Four of us in our family have had laparascopic RNY because it offers the patient less post-op discomfort and a faster recovery period, but the "inside work" is exactly the same. Regardless of the surgical approach, remember that this is still a major surgery. Be sure to allow your body adequate time for rest and recovery :-)
   — Diana T.

May 16, 2002
Both. I had both. Open, both times. The second was open by choice. My doc didn't transect in the olden days. Of my peers, I was one of the last to disrupt (5 yrs), so that means they were already disrupted & revised by that time. For some reason, my pouch is far more comfy now than it was and that seems impossible as they didn't change it that much! But I suspect before that I had at the very least, a slight compromise in the staple line that allowed a small amount of acid back into the pouch. Until it "went", then it was like a geyser of acid back into the pouch. Wow. Given a choice, transect.
   — vitalady